Abstract
BackgroundHigh-dose benzodiazepine dependence constitutes a major clinical concern. Although withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. More recently, a benzodiazepine maintenance approach has been suggested as an alternative for patients’ failing discontinuation treatment. While there is some data supporting its effectiveness, patients’ perceptions of such an intervention have not been investigated.MethodsAn exploratory qualitative study was conducted among a sample of 41 high-dose benzodiazepine (BZD)-dependent patients, with long-term use defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use, such as mixing substances, dose escalation, recreational use, or obtainment by illegal means. A qualitative content analysis approach was used to evaluate findings.ResultsParticipants generally favored a treatment discontinuation approach with abstinence from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance treatment approach with continued prescription of a slow-onset, long-acting agonist was viewed ambivalently, with responses ranging from positive and welcoming to rejection. Three overlapping themes of maintenance treatment were identified: “Only if I can try to discontinue…and please don’t call it that,” “More stability and less criminal activity…and that is why I would try it,” and “No cure, no brain and no flash…and thus, just for everybody else!”ConclusionsSome patients experienced slow-onset, long-acting BZDs as having stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider treatment alternatives if discontinuation strategies fail.
Highlights
High-dose benzodiazepine dependence constitutes a major clinical concern
While types of intervention differ, evidence exists that high-dose-dependent individuals, in particular, are not very successful in completing the withdrawal treatment or in abstaining from BZD use in the long term [1, 12,13,14]
We found that some high-dose-dependent users who looked for euphoric effects opposed a maintenance approach because they feared and had experienced that their sought-after BZD “flash” was eliminated when they took slow-onset, long-acting BZDs
Summary
High-dose benzodiazepine dependence constitutes a major clinical concern. withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. High-dose benzodiazepine (BZD) dependence is an increasingly recognized clinical problem, and there is ongoing debate about its definition [1, 2] and optimal treatment strategies [3,4,5,6]. This form of dependence is not confined to users who exceed a set amount of diazepam equivalents, Liebrenz et al Harm Reduction Journal (2016) 13:1. The authors concluded that a specific group of high-risk patients with long-term heroin and BZD dependence and multiple attempts at BZD abstinence might fare better with a maintenance treatment approach [20]
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